不同液体复苏对失血性休克兔微循环及炎性因子的影响  

Effects of Different Fluids on Microcirculation and Inflammatory Factors in Rabbits with Hemorrhagic Shock

作　　者：丁文淞 屈启才[1] 李鸿[1] 杨柳[1] 陶建平[1] 思永玉[1] DING Wensong;QU Qicai;LI Hong;YANG Liu;TAO Jianping;SI Yongyu(Dept.of Anesthesiology,The 2nd Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650101,China)

机构地区：[1]昆明医科大学第二附属医院麻醉科,云南昆明650101

出　　处：《昆明医科大学学报》2023年第12期13-19,共7页Journal of Kunming Medical University

基　　金：云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目(202001AY070001-223)。

摘　　要：目的研究不同类型液体复苏对失血性休克兔肠系膜微循环及炎性因子的影响。方法从兔颈总动脉处放血使平均动脉压较基础值下降40%,建立失血性休克模型。随机分成实验对照组、生理盐水组、乳酸林格组、醋酸林格组、羟乙基淀粉组以及琥珀酰明胶组,每组8只。肠系膜微循环用微循环观测仪监测。记录放血前(T_(0))、失血性休克时(T_(1))、液体复苏开始时(T_(2))、液体复苏完成时(T_(3))、实验结束时(T_(4))各组的平均动脉压(MAP)、心率(HR)、微循环灌注血管比例(PPV)和微血管血流指数(MFI);测定T_(0)、T_(2)、T_(4)时刻肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)和乳酸(Lac)含量。结果乳酸林格组与羟乙基淀粉组的T_(3)时刻MAP比较,差异有统计学意义(P<0.05),除外琥珀酰明胶组,羟乙基淀粉组在T_(4)时刻的MAP高于其他组别,差异有统计学意义(P<0.05),T_(4)时刻实验对照组与各组差异有统计学意义(P<0.05);除外琥珀酰明胶组,T_(4)时刻羟乙基淀粉组和琥珀酰明胶组的PPV及MFI均高于生理盐水组、乳酸林格组、醋酸林格组(P<0.05),T_(4)时刻羟乙基淀粉组乳酸值最低,与乳酸林格组、生理盐水组比较,差异有统计学意义(P<0.05),T_(4)时刻,各组与实验对照组差异有统计学意义(P<0.05);各组TNF-α及IL-1在T_(0)、T_(2)、T_(4)时刻比较,差异均无统计学意义(P>0.05)。结论羟乙基淀粉液和琥珀酰明胶液可以改善失血性休克兔的微循环,但不能改善失血性休克兔的炎性因子水平。Objective To study the effects of different types of fluid resuscitation on mesenteric microcirculation and inflammatory factors in rabbits with hemorrhagic shock.Methods The model of hemorrhagic shock rabbits was established by reducing the basic mean arterial pressure by 40%through draining the blood from the common carotid artery.Animals were randomly divided into control group,saline group,lactate Ringer group,acetic acid Ringer group,hydroxyethyl starch group and succinyl gelatin group with 8 animals in each group.Mesenteric microcirculation was monitored with microcirculation monitor.Mean arterial pressure(MAP),heart rate(HR),microvascular perfusion ratio(PPV)and microvascular blood flow index(MFI)were recorded before bleeding(T_(0)),at hemorrhagic shock(T_(1)),at the beginning of fluid resuscitation(T_(2)),at the completion of fluid resuscitation(T_(3)),and at the end of the experiment(T_(4)).The contents of tumor necrosis factor-α(TNF-α),interleukin-1(IL-1)and lactic acid(Lac)were measured at T_(0),T_(2) and T_(4).Results Compared with hydroxyethyl starch group,there were statistically significant differences in T_(3) MAP(P<0.05),except for succinyl gelatin group,hydroxyethyl starch group had higher MAP at T_(4) than other groups,the difference was statistically significant(P<0.05).The differences in MAP between experimental control group and other groups were statistically significant at T_(4)(P<0.05).PPV and MFI of hydroxyethyl starch group and succinyl gelatin group were higher than those of normal saline group,lactic acid Ringer group and acetic acid Ringer group at T_(4)(P<0.05),and the lactic acid value of hydroxyethyl starch group at T_(4) was the lowest,compared with lactic acid Ringer group and normal saline group,the difference was statistically significant(P<0.05).There were statistical significances between all groups and experimental control group at T_(4)(P<0.05).There were no significant differences in TNF-αand IL-1 in T_(0),T_(2) and T_(4) among all groups(P<0.05).Conclusion Hydroxyethy

关 键 词：失血性休克 兔 液体复苏 微循环 炎性因子 

分 类 号：R363.2[医药卫生—病理学]